We are conducting a randomized controlled trial the use of rib raising for post-operative ileus. Rib raising is an osteopathic manipulative technique (OMT). We will recruit all patients undergoing major abdominal surgery and once they have been enrolled, we will randomize them to receive daily rib raising or a control technique where we place hands on the back but do not apply any pressure. In preliminary studies, Rib raising has been shown to reduce post-operative ileus and hospital length of stay by up to 50%.

Inclusion Criteria:

• Major abdominal surgery (laparotomy, laparoscopy excluding simple laparoscopic appendectomy or laparoscopic cholecystectomy)

Exclusion Criteria:

• Open abdomen for >72 hours
• Prior history of major post-operative complications
• Intolerance to anesthesia
• Co-morbidities including osteoporosis and osteopenia
• Spine or rib fractures
• Pregnancy
• Prisoners
• History of osteopathic manipulation
• Recruitment delayed beyond 48 hours
• Surgeon requested exclusion